Accuracy of anterior intra-articular injection of the glenohumeral joint

https://doi.org/10.1016/j.arthro.2004.09.009Get rights and content

Purpose: Intra-articular glenohumeral injections are an important part of orthopaedic practices, and the therapeutic benefit and diagnostic information of certain injections is based on the premise of the injection reaching its desired target. This study assessed the accuracy of an anterior intra-articular injection in awake subjects without radiologic assistance.Type of study: Case control study. Methods: Forty-one patients scheduled for magnetic resonance imaging arthrography underwent anterior placement of a spinal needle using a location just lateral to the coracoid as the anterior landmark for injection, without radiographic assistance. After the needle was placed and clinically estimated to be intra-articular, 1 mL of gadolinium was injected into the joint to determine accuracy of position. The presence of intra-articular contrast was judged as an accurate injection. Results: Only 26.8% (11 of 41) of injections placed anteriorly were actually intra-articular. The remaining were extra-articular, the most common location of error being either too medial or too superficial in the deltoid muscle. Conclusions: Based on our cadaveric study, we believed that an unassisted anterior injection to the glenohumeral joint would be accurately placed. However, this study shows that without some form of radiologic guidance, it is unlikely that an anteriorly placed intra-articular glenohumeral injection will be accurately placed in awake patients, and we do not recommend this technique. Level of evidence: Level IV.

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Methods

Forty-one patients scheduled for magnetic resonance imaging (MRI) arthrography were identified for the study. The patients all had the presumed diagnosis of rotator cuff tear or labral tear and were accordingly scheduled for MRI arthrography. Patients were studied consecutively. Body-mass index or habitus were not recorded. There were no exclusion criteria.

A single examiner performed all of the injections (S.K.); the single operator was well versed in anatomy and he performs hundreds of

Results

There were 31 male and 10 female patients. The average age was 45 years (range, 17 to 77 years). The patients diagnoses (after MRI) were rotator cuff tear in 11, superior labral tear in 8, partial rotator cuff tear in 4, osteoarthritis in 1, and normal for the remaining 12 subjects. No patients had undergone any previous surgery.

Of the injections placed anteriorly, 26.8% (11 of 41) were actually intra-articular. The remaining were extra-articular, the most common location of error being either

Discussion

The accurate placement of intra-articular injections may be taken for granted. Inaccurately placed injections will limit the diagnostic yield of the injection. Similarly, inaccurate injection will limit the therapeutic yield of the injection.2 Furthermore, misplaced steroid may damage tendons such as the rotator cuff.4 Therefore, it is very useful to know the likelihood of accurate injection placement. Our unpublished data suggested that an anterior injection would be accurate 80% of the time

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